摘要
背景:下胫腓联合损伤是踝关节损伤常见的并发症,尤其在旋转型踝关节骨折中,是一种需要特别重视的损伤部分。下胫腓联合损伤的临床经典治疗方法是一至两枚横行螺钉坚强内固定,随着微创技术的发展,下胫腓联合弹性固定的临床使用更加广泛。目的:探讨关节镜下复位踝关节下胫腓联合,对比胫腓联合螺钉和TightRope纽扣钢板固定的稳定性。方法:纳入东莞市中医院2016年1月至2019年8月收治的踝关节骨折伴下胫腓联合损伤患者51例,均进行踝关节镜下复位,随机分为2组。其中横行螺钉组23例采用胫腓联合螺钉固定,TightRope组28例采用TightRope纽扣钢板固定。比较两组患者术后负重时间和并发症发生情况,采用末次随访步态分析以及美国足踝外科协会踝与后足评分评估踝关节功能。结果与结论:(1)51例患者获得6-18个月随访;(2)TightRope组术后部分负重时间、完全负重时间较螺钉组明显缩短,差异有显著性意义(P<0.05);(3)两组患者末次随访时步态分析评分比较差异无显著性意义(P>0.05);(4)两组末次随访美国足踝外科协会踝与后足评分比较差异无显著性意义(P>0.05),优良率均为100%;(5)提示踝关节镜下复位可以更准确地恢复下胫腓联合结构;与横行螺钉相比,TightRope纽扣钢板治疗下胫腓联合损伤在提供足够固定强度、稳定下胫腓联合的前提下可以让患者更早下地负重,但远期疗效尚不确定。
BACKGROUND:Syndesmosis injury is usually a common complication after ankle sprain,especially with rotation type of malleolar fracture,and is a damaged part that needs special attention.The classical therapy of syndesmosis injury is syndesmosis fixation with one or two screws.As the minimal invasive technique developed,syndesmosis flexible fixation is more widely used.OBJECTIVE:To investigate the arthroscopic reduction of the lower tibiofibular syndesmosis of the ankle,and compare the clinical efficacy of tibiofibular syndesmosis screw and TightRope fixation.METHODS:From January 2016 to August 2019,51 patients with ankle joint fracture and distal tibiofibular syndesmosis injury were randomly divided into two groups.Arthroscopic ankle reduction was performed in both groups,including 23 cases in metal screw fixation group and 28 cases in TightRope fixation group.The weight-bearing time and postoperative complications were compared between the two groups.Ankle function was evaluated by gait analysis and American Orthopaedic Foot and Ankle Society score at the last follow-up.RESULTS AND CONCLUSION:(1)51 patients were followed up for 6 to 18 months.(2)The partial and full weight-bearing time of TightRope fixation group was significantly shorter than that of metal screw fixation group(P<0.05).(3)There was no significant difference in gait analysis between the two groups at the last follow-up(P>0.05).(4)There was no significant difference in American Orthopaedic Foot and Ankle Society score between the two groups at the last followup(P>0.05),and the excellent rates both were 100%.(5)Arthroscopic ankle reduction can more accurately restore the structure of the lower tibiofibular syndesmosis.Compared with metal screw,TightRope in the treatment of distal tibiofibular syndesmosis injury can provide enough fixation strength,which can make patients load weight underground earlier,but the long-term effect is uncertain under the premise of stable tibiofibular syndesmosis.
作者
苏博源
姚彬富
曾广龙
叶仲森
谢庆祥
Su Boyuan;Yao Binfu;Zeng Guanglong;Ye Zhongsen;Xie Qingxiang(Department of Orthopedic Surgery,Dongguan Hospital(Dongguan Hospital of Traditional Chinese Medicine),Guangzhou University of Chinese Medicine,Dongguan 523000,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第30期4845-4850,共6页
Chinese Journal of Tissue Engineering Research
关键词
踝关节镜
下胫腓联合
TIGHTROPE
胫腓联合螺钉
复位
内固定
ankle arthroscopy
tibiofibular syndesmosis
TightRope
tibiofibular syndesmosis screw
reduction
internal fixation